| NPI | 1447577143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1956) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 1956) |
| 101YM0800X Counselor, Mental Health (Licence: MN 1956) | |
| 103K00000X Behavior Analyst (Licence: MN 1956) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2010-04-21 |